Comparative Epidemiologic Survey of Measles in Two Primary Schools / 예방의학회지

ABSTRACT

OBJECTIVES: During March-May, 2000, a measles outbreak occurred at Youngduk, Korea. This county is divided into two areas with different historical and socioeconomic background. The outbreak occurred in one of these areas. We conducted a comparative epidemiologic study on the two areas in order to evaluate the factors related to the epidemic. MATERIALS AND METHODS: We selected two groups, grades 3 and 5 in a primary schools in each area. We investigated outbreak-related factors using parent-questionnaires, the vaccination history from the students health record and the records concerning the recent measles-outbreak from the local health center. Serologic test on measles-IgG and -IgM antibody was done. RESULTS: The infection rate was 31.6% for the epidemic area and 3.7% for non-the epidemic area according to clinical or serological criteria (p<0.001). No difference was seen in the measles vaccination rate, residence at the time of vaccination or past measles infection history between the two areas. In the epidemic area, the attack rate for the 4-6 year-old MMR booster group(20.5%) was higher than the non-booster group(32.4%), but was not found significantly. Vaccine efficacy was 29.6% in the epidemic area and 87.0% in the non-epidemic area (p<0.001). The IgG level and positive rate were significantly different between the two areas (median 10727 IU/ml, 98.9% in epidemic area; median 346 IU/ml, 85.9% in the non-epidemic area, p<0.001). However, the IgG level and positive rate between the measles-cases and non-cases were not significantly different. CONCLUSIONS: This outbreak took place in mostly vaccinated children. These results suggest that a reduction of herd immunity for immunity failure after vaccination may be one of the feasible factors related to the outbreak pattern in the two areas. The results of the IgG level and positive rate suggest that re-establishment of a normal value for IgG level and of a qualitative method for IgG are needed.